Optimal adherence to combination antiretroviral therapy is essential to the health of older people living with HIV (PLWH), however, the literature on adherence and aging is limited. Using Medicaid data from 29 states (N = 5177), we explored correlates of optimal adherence among older PLWH. The prevalence of optimal adherence was low (32 %) in this study. Males were more adherent than females (APR = 1.11, 95 % CI 1.02-1.21, P = 0.0127); persons with three or more co-morbidities (APR = 0.67, 95 % CI 0.60-0.74, P < 0.001), two co-morbidities (APR = 0.86, 95 % CI 0.75-0.98, P = 0.0319) and one co-morbidity (APR = 0.82, 95 % CI 0.73-0.92, P = 0.0008) were less adherent than those without any co-morbidity; and residents of rural areas (APR = 0.90, 95 % CI 0.63-0.98, P = 0.0385) and small metropolitan areas (APR = 0.82, 95 % CI 0.72-0.94, P = 0.0032) were less adherent than residents of large metropolitan areas. There were no racial differences in optimal adherence. Targeted interventions that provide adherence support, case management, and peer navigation services may be of benefit in achieving optimal adherence in this population.
Alcanzar una óptima adherencia a la terapia antiretroviral es esencial para mantener la salud de adultos mayores viviendo con VIH (PVVIH). Sin embargo, hay una escasez de estudios enfocados en adherencia en adultos mayores. Usando datos de Medicaid provenientes de 29 estados, exploramos factores que afectan la adherencia en PVVIH que son adultos mayores. La prevalencia de adherencia óptima fue baja (32 %) entre los 5177 participantes. Los hombres fueron más adherentes que las mujeres [razón de prevalencia ajustada (RPA) = 1.11, 95 % intervalo de confianza (IC) = 1.02–1.21, P = 0.0127]; mientras que personas con tres o más comorbilidades (RPA = 0.67, 95 % IC 0.60–0.74, P < 0.001), dos comorbilidades (RPA = 0.86, 95 % IC 0.75–0.98, P = 0.0319), y una comorbilidad (RPA = 0.82, 95 % IC 0.73–0.92, P = 0.0008) fueron menos adherentes que aquellos sin comorbilidades. Residentes de áreas rurales (RPA = 0.90, 95 % IC 0.63–0.98, P = 0.0385) y áreas metropolitanas pequeñas (RPA = 0.82, 95 % IC 0.72–0.94, P = 0.0032) fueron menos adherentes que los residentes de grandes áreas metropolitanas. No hubo diferencias raciales en adherencia óptima. Intervenciones enfocadas a proveer apoyo de adherencia, coordinación de servicios y navegación por pares son críticas para alcanzar una adherencia óptima en esta población.
Keywords: Aging; Antiretroviral adherence; HIV/AIDS; Older adults; People living with HIV.